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Former cleanup workers blame illnesses on toxic coal ash exposures

The Tennessee Valley Authority’s Kingston Fossil Fuel Plant looms above parkland today. The area was once coated by coal ash mounds measuring up to 60 feet tall.Kristen Lombardi/Center for Public Integrity

Dozens of lawsuits are pending as a result of a 2008 dam collapse in Tennessee

Introduction

KINGSTON, Tenn. — It was April 28, 2014, five years after Craig Wilkinson’s 12-month stint as a backhoe operator at a massive coal-ash spill in Tennessee. Wilkinson was desperate for answers. Bearing a list of metals — arsenic, lead, mercury and others concentrated in coal ash — he arrived at a clinic specializing in toxic exposures. Maybe someone there could tell him what was coursing through his body.

Wilkinson, then 56, adopted a “weather-through-it” mentality on the job. But his body had betrayed him since he had signed on as a cleanup worker following a dike failure that unleashed a billion gallons of ash from a Tennessee Valley Authority power plant.

His vision grew dull, his head dizzy. Within months, he experienced a cough so persistent that it left him gasping for breath. By 2012, he was diagnosed with chronic obstructive pulmonary disease, a lung ailment. He attributed the condition to an old smoking habit — until his lungs worsened. A nodule sprouted on one lobe; pneumonia wreaked havoc on both. When he began coughing up blood, he suspected a connection to his work.

The TVA spill marked a turning point in the debate over the dangers of coal ash, an often-toxic byproduct of coal-fired electricity. In December 2008, an earthen dam collapsed at a pond brimming with ash generated by the utility’s Kingston Fossil Fuel Plant, 36 miles southwest of Knoxville. The cascading waste deluged nearly 400 acres in gray muck, destroying houses and dirtying a river, along with several inlets. It ranks among the largest industrial disasters in American history.

The disaster thrust coal ash disposal into the public consciousness. Immediately afterward, the U.S. Environmental Protection Agency pledged to regulate this industrial waste, sparking a battle in Washington that is still playing out. In 2014, the agency set national standards that amount to guidelines for the states — guidelines that call for treating the ash as if it were household trash. Weakened by loopholes, the EPA rule is the product of vigorous lobbying by the utility industry. Across the country, meanwhile, coal ash has fouled water sources and endangered public health.

But little attention has been paid to workers like Wilkinson. Records show employees at individual power plants have complained to federal health investigators about ill effects from ash exposure as far back as the 1970s. The broader question of occupational harm remains unknown. Overwhelmingly, the body of research on coal ash has examined its risks to the environment and the health of communities abutting the nation’s 1,400 ash ponds and landfills — not workers.

“This whole question of worker exposure has been vastly underexplored,” says Barbara Gottlieb, the environment and health director at Physicians for Social Responsibility, who co-authored a report on illnesses caused by the ash’s most common contaminants in 2010. There is scant information available on those working at regulated coal ash dumps, she says, let alone unregulated sites where the ash gets recycled.

“I’m sure there is a lot of routine exposure,” Gottlieb says, but “we aren’t paying attention to this class of workers.”

Now, some workers are stepping forward and filing lawsuits targeting specific ash sites. More than a half-dozen such cases have surfaced around the country in the past three years. Most of the litigation alleges workers handled coal ash without proper protection, exposing them to contaminants and making them sick; the workers say they were led to believe the ash was safe. Lawsuits are pending against an Ohio-based utility, a Utah ash-recycling company and a TVA contractor; each defendant has denied the allegations in court filings. A fourth case filed by a contractor against a Virginia utility was dismissed.

As for Wilkinson, tests revealed a frightening stew of chemicals in his urine.

Thousands of exposed workers

Maryland lawyer Roy Mason says worker exposure to coal ash remains “very much under the radar.” In 2013, he filed two wrongful-death suits in Utah district court against the ash-recycling company based in that state on behalf of the widows of two welders who, for 12 years, had repaired its ash-storage facilities. According to the complaints, the welders, wearing only safety goggles, stood inside metal silos, waist-deep in ash, as clouds of dust swirled overhead. In 2010, both developed cancer.

“I guarantee there are thousands of [workers] out there exposed to coal ash and sick because of it,” Mason says.

Dozens have surfaced in lawsuits involving the TVA spill. In 2013, 35 workers and 17 spouses sued the primary contractor for the Kingston cleanup, charging that the company knew about the ash’s risks but failed to protect them. Workers were sickened by “continuous, unlawful exposure to . . . hazardous substances associated with the toxic ash,” according to the complaint, and have suffered ailments such as skin irritations, and neurological, respiratory and pulmonary problems. The lawsuits accuse Jacobs Engineering Group — the contractor hired by TVA to manage hazards posed by the ash during the Kingston cleanup — of misleading workers about safety, as well as failing to provide proper protective equipment, air monitoring and safety training, among other allegations. Last year, another 15 workers, including Wilkinson, and two workers’ spouses filed similar claims.

Jacobs declined to comment for this article, citing the pending litigation. But in a 2013 court filing, it called the workers’ claims “scurrilous,” and moved to dismiss them. The company developed a safety and health plan for the TVA spill site that, according to its filing, “identifies various hazards . . . including constituents of [coal] ash,” which was approved by TVA and disseminated to subcontractors and their workers. Ash exposures, it said, never exceeded allowable limits.

Waste generator TVA declined interview requests and did not respond to written questions from the Center for Public Integrity. The utility, while not named a party in the workers’ complaints, cited the litigation in a brief statement provided to the Center. “TVA will not be part of trying a case in the media before the courts,” it said. During the cleanup, the utility issued statements touting its commitment to worker health and safety and its efforts to monitor coal ash exposures.

“Protecting public health and the environment has been a priority,” it said in a 2014 news release. “TVA partnered . . . to analyze thousands of air and water samples to confirm that the air and water continue to meet public health standards.”

Records suggest federal labor investigators rarely appeared on the spill site. A response to a Freedom of Information Act request filed by the Center shows that the Occupational Safety and Health Administration received a complaint in 2009 about working conditions there. Workers were “over-exposed” to radiation and arsenic and “working without respirators,” the complaint alleged. OSHA deferred to TVA to investigate the alleged violations. The results of that investigation are unclear: 68 of the 93 pages in the OSHA file provided to the Center were redacted. Records show OSHA inspectors conducted only one health inspection at the site in 2011, which yielded no citations. By the time Wilkinson heard that cleanup workers were getting sick, he had already been wondering about his time at the TVA spill in 2009 and 2010. It seemed to coincide with what he calls his “downhill slide.”

At the clinic, Wilkinson gave urine samples. Tests revealed the presence of 11 metals in his urine, including unusually high levels of lead, mercury and uranium. A specialist suggested that two of the metals — cadmium and nickel — could have come from Wilkinson’s 30 years as a smoker, but not the rest.

“It was like the light bulb going on for me,” says Wilkinson, who no longer smokes. “That was an ‘ah-ha’ moment.”

In the days and weeks following the TVA disaster, coal ash coated nearly 400 acres of rural landscape in Kingston, Tenn., in gray muck. Workers remember being immersed in the slurry up to their knees.

Courtesy of Ansol Clark

‘They made it nice’

In Kingston, where grassy knolls and glistening rivers coalesce, it is hard to find signs of the nation’s largest coal-ash catastrophe. Once blanketed in dirty sludge, which ruptured gas lines, blocked rail cars and clogged the Emory River, the TVA spill site is now covered with vegetation; the area around the plant has been transformed into a public park, with fishing docks and manicured trails.

After an extensive cleanup and study — during which 100 scientists monitored everything from water quality to wildlife — government officials and academic researchers alike have concluded the coal-ash contamination will cause little lasting harm. In 2015, federal authorities shuttered the so-called Kingston Recovery Effort, declaring the remediated site mostly ash-free. By then, the cleanup had taken six years and cost $1.2 billion.

“They made it nice is all I know,” says Johnny Church, 66, a retired laborer who shoveled coal ash at the spill site for four years. Unlike most, Church wore some protective gear while doing what he calls “all the dirty work” — a Tyvek suit, a dust mask. Now diagnosed with leukemia, he is among the 6 percent of 900 total cleanup workers who have signed onto the coal-ash lawsuits.

Taking in the well-groomed parkland, he says, “It looks nothing like it did when we were in it, breathing this stuff every day.”

In the aftermath of the TVA spill, the ash slurry — enough to fill 153 Olympic-sized swimming pools — extended 300 acres beyond the plant’s 84-acre “containment area,” forming “ash bergs” up to 60 feet tall. The Emory turned thick and brown, like a chocolate milkshake. On land, the ash hardened into gray craters and mounds resembling the surface of the moon.

Workers spent much of the ensuing four years moving the ash — 5.4 million cubic yards in all. They used dredging machines to scrape it, excavators to scoop it, bulldozers to shovel it. “It was like an assembly line of ash,” says Wilkinson, who, stationed atop a backhoe, pushed ash piles from the shore toward a platform, where the material was loaded onto railroad cars bound for an Alabama landfill.

Many remember being immersed in this slurry, wading in it up to their knees. The sludge, dense and constricting, pulled boots off their feet. Wet ash doused their clothes. By the end of a 12-hour shift, workers found the ash caked on their hands, face, hair and teeth. “It was like working in a mud hole,” says Ansol Clark, 65, a retired truck driver who, from 2009 to 2013, traversed the site all day, every day, delivering fuel to 350 pieces of machinery. He wore the standard garb: a hard hat, safety glasses, gloves.

Once the coal ash dried, a gray dust overtook the site. Workers say it coated even the biggest machines; inside cabs, it covered floorboards, dashboards, windows. Some recount flipping on the heat, only to get a blast of it in the face. To them, ash dust seemed to infiltrate everything — the lunch trailer, the portable toilets, their own cars.

Many describe it as having a chalky taste, a chemical smell. At night, ash particles hung in the air, shining like crystals in the sky.

Those on this early cleanup had little reason to wonder what those particles contained. No one in authority discussed the ash’s hazards at first, workers say. They say they remember Jacobs supervisors playing down the dangers, likening the ash to dirt. A former employee of a subcontractor who took orders from TVA managers backs up these claims.

“They actually told us we could eat two pounds a day,” head foreman Bradford Green testified in a deposition associated with one worker’s case. “It wouldn’t hurt you.”

Such assurances echoed the official word at the time. In the aftermath of the spill, TVA — a federally owned utility — issued multiple statements on potential health hazards posed by coal ash. All were reassuring. In a 2009 report examining the initial response to the disaster, the TVA’s inspector general criticized the utility’s release of “inaccurate and inconsistent information.” TVA public-relations employees, for example, took a red pen to one “talking points” memo, deleting references to the ash’s “risk to public health and risk to the environment” and inserting descriptions of it as “mostly . . . inert.”

“TVA was downplaying and denying . . . the disaster,” says Gregory Button, a retired anthropology professor at the University of Tennessee who has studied environmental calamities. He interviewed dozens of residents, workers and officials about the spill, and remembers utility employees and contractors insisting the ash was harmless.

“They thought they could gloss over it,” says Button, who wrote about what he calls the “doubt and misinformation” generated by TVA in a 2010 book about disaster culture.

Government data contradicted the TVA rhetoric. In December 2008, the EPA tested river water after the spill and found elevated levels of eight heavy metals. Arsenic was present in the Emory in concentrations 149 times safety standards. Independent scientists concurred. A team of researchers mostly from Duke University also detected contaminants — especially arsenic — in surface waters. They found high levels of arsenic and radium in the ash itself and warned that airborne dust could pose “a severe health impact on local communities and workers.”

“It was a double whammy or worse,” Laura Ruhl, the lead Duke researcher and now a University of Arkansas earth sciences professor, says of the combination of toxic metals and radioactivity.

Shea Tuberty, a biologist and environmental toxicologist at Appalachian State University, worked with another team of researchers assessing the ecological fallout in the Emory River from the TVA spill — 17 metals in the ash, including arsenic in concentrations up to 300 times safety standards. What alarmed him most, he says, were cenospheres, components of coal ash produced by the combustion process.

Tuberty likens cenospheres to Christmas tree ornaments: They are round, hollow particles that break into tiny, sharp fragments. They consist mostly of silica and aluminum. His analysis of the TVA ash showed that some cenospheres contained what he calls “really interesting gel bubbles.” That gel turned out to be iron oxide coated with arsenic at levels exceeding by the thousands the health thresholds for aquatic and human life.

Inhaled, these microscopic particles can cause damage in two ways, he says: by their sharp edges and by the toxic metals they harbor.

To Tuberty, the implications for cleanup workers seem obvious. “Somebody standing in the ash, shoveling it in the truck?” he asks. “If they weren’t wearing masks, forget it.”

Retired laborer Johnny Church, who shoveled coal ash at the TVA spill site, stands on a dock in the former disaster zone, which is now a public park.

Kristen Lombardi/ Center for Public Integrity

‘Dust, dust, dust’

In May 2009, the EPA became a presence on the TVA spill site, ironing out an agreement to oversee the utility-financed cleanup under the federal Superfund law. At the time, EPA officials were debating whether to categorize coal ash as “hazardous” — a distinction required by the law. Under an administrative order and consent agreement, they classified the TVA ash as a “pollutant” containing arsenic, cadmium, copper, lead, mercury, nickel, selenium and zinc. All are hazardous substances as defined under Superfund.

The Superfund designation ushered in a methodical operation. Jacobs developed a 319-page plan addressing workplace safety and health for the Kingston cleanup. Its plan outlined mandatory training, testing requirements and use of protective equipment. It also identified “major hazards,” including “chemical hazards associated with handling [coal] ash.” Under the plan, workers attended safety briefings and training sessions at which, they say, TVA and Jacobs managers highlighted basic procedures — no eating or drinking in ash-laden trucks, for instance. EPA officials established a protocol for entering and exiting the site, complete with a wash station for vehicles and workers’ boots.

The EPA trained much of its attention on dust. It installed five air monitors around the spill perimeter, and implemented dust-suppression measures. Workers remember dousing areas around these monitors to keep billowing clouds on site from escaping into nearby neighborhoods. At one point, according to the EPA, eight “water pigs” circled the property, spraying down surfaces.

Craig Zeller, a project manager in the EPA’s Superfund program who oversaw the Kingston recovery effort, says the mission was simple: “Keep it wet. Keep it wet.” TVA executives attempted other tactics to prevent dust from blowing around — dropping grass seed on coal ash, for example, and sprinkling it with a dust suppressant known as Flexterra.

“On Day One we were keenly aware of dust, dust, dust,” Zeller says. The EPA maintained the dust controls and air monitoring over the next five years until 2014 to safeguard local residents.

TVA and Jacobs safety managers were tasked with monitoring occupational exposures to coal ash. On the job, supervisors handed out personal air monitors to select cleanup workers to test whether they were exposed to unsafe levels of “respirable dust, silica dust, silica quartz, silica cristobalite,” according to worker records. (Silica exposure can cause the deadly lung disease silicosis, as well as lung cancer). Small box-like badges were pinned on those deemed to be at “high risk” by the companies, Zeller says — those who came in frequent contact with coal ash.

“If that was you, you had a personal air filter provided by TVA or Jacobs,” says Zeller, who never wore the device himself because “I was not outside eight hours a day.”

Many who were in the thick of the ash say they never received personal air monitors. Those who did say they rarely saw copies of monitoring results. If they did, their filters always seemed to register levels of exposures below permissible limits, records show. Most came to doubt the tests reflected an accurate workplace environment.

Former workers say other safety practices failed to materialize as well. They remember being told they would be fitted for respirators “but that never happened,” says Billy Gibson, 42, who was on the TVA spill site from 2009 to 2014 — first as a heavy-equipment operator and then as a foreman. Years passed before Gibson would request a respirator fitting, he says, to little avail. Some remember Jacobs executives stocking supply closets with dusk masks, only to let the masks sit on shelves.

“It was a common narrative that [workers] were being denied protective equipment,” says anthropologist Button. He recalls attending a public hearing held by the EPA and TVA, during which a worker’s wife complained that her husband kept bringing home ash-coated clothes.

Of the 900 cleanup employees, workers say only the 200 or so laborers were regularly issued protective equipment. They included Church, who shoveled coal ash out of bulldozer tracks and hosed it off dump truck fenders. At the start, he received Tyvek suits and “little old masks like the kind you wear cutting grass,” he says. The ash soaked his hazmat suit so thoroughly that he had to change it several times per shift, Church says. When he vacuumed vehicles, the dust burned his nostrils. “Those little masks did nothing,” he says.

By the fall of 2009, Church sensed that something was seriously wrong. He felt fatigued; his bones ached. A tingling sensation spread across his hands and feet. Within months, he would undergo a battery of blood tests revealing high levels of lead and a diagnosis of leukemia that his doctor would later attribute to “his exposures to acute concentrations of chemicals in the ash spill,” records show.

Over the ensuing months and years, other workers experienced their own symptoms. Some developed skin allergies, breaking out in red, itchy blisters on their arms and faces. Others endured recurring headaches, diarrhea and nosebleeds. Still others blew out black mucus and coughed up black phlegm. So many workers developed the same respiratory condition that they began calling it the “fly ash flu.”

No one dared to confront TVA and Jacobs supervisors, workers claim, fearing their complaints could cost them well-paid, steady jobs.

“Nobody talked about the coal ash,” says Mike McCarthy, a 53-year-old heavy-equipment operator who worked on the spill for nearly five years. “It was taboo to talk about anything.”

‘Collateral damage’

In the nearly eight years since the TVA disaster, a fundamental question has gone unanswered: What is the outlook for those, like Craig Wilkinson, who hauled, dumped, shoveled and spread coal ash with little or no protection?

It is not that the government has ignored the ash’s potential hazards. Days after the TVA spill, Kingston residents complained about worsening symptoms they feared were linked to ash exposures. In a 2009 survey conducted by Tennessee health authorities, 40 percent of 177 households within a mile and a half of the disaster zone reported developing respiratory conditions, such as wheezing, coughing and shortness of breath. Some petitioned for a formal evaluation of the spill’s health impacts; in a 2010 assessment, state epidemiologists concluded the ash “should not have caused harm to the community’s health.”

TVA, for its part, commissioned a medical-monitoring program for residents of Roane County, in which the Kingston plant is located. Over eight months in 2010, people from 150 households within two miles of the facility underwent physical exams, blood counts, chest X-rays and other tests measuring “effects on the body related to exposure to [coal] ash,” a 2010 report states. Medical evaluators found there were “no expected long-term effects on physical health” caused by the coal ash spill.

Both evaluations sparked criticism for what Button calls their “soft-sell” conclusions. Neither considered effects on cleanup workers.

The inattention to workers extends beyond Kingston. No one has done a comprehensive study on the health consequences of coal ash for the untold thousands handling the waste daily. Kristina Zierold, of the University of Louisville, who has studied the ash’s effects on human health, says few epidemiologists have explored the topic — partly because coal ash is an “emerging environmental problem,” and partly because American workers are “a forgotten population.”

She has scoured the scientific literature, finding fewer than a half-dozen occupational studies. Some date to the 1980s. Others examined utility employees in China. Taken together, the studies found higher rates of lung problems and cancer among workers exposed to coal ash.

Zierold’s own work suggests the ash can be harmful. In 2012, she looked at the prevalence of disease in communities abutting coal-ash dumps in Louisville. Over a year, she compared medical diagnoses and symptoms of 231 people in “exposed” neighborhoods to 170 “non-exposed” controls. The first group had higher rates of lung diseases, kidney problems and heart attacks, among other illnesses. The exposed residents also reported experiencing more ill effects, from skin rashes and respiratory symptoms to neurological conditions.

Zierold is now examining neurobehavioral symptoms like attention deficit disorder and other learning disabilities among children exposed to coal ash. Backed by the National Institute of Environmental Health Sciences, part of the National Institutes of Health, the five-year study is the only federally funded research exploring a possible link between coal ash and poor health.

Zierold says that no researcher has found a “direct hit that says [coal] ash is associated with this [ailment].”

But some things are known. Scientists and physicians say the biggest threat to human health — be it workers or anyone else — is airborne coal-ash dust. Because the ash is often fine and powdery, its particles can blow off dump trucks and disposal piles, easily becoming re-suspended in the air. Experts say this “fugitive dust” is extremely dangerous. It can be inhaled, absorbed through the skin or ingested.

Gottlieb, of Physicians for Social Responsibility, notes there was a problem with fugitive dust on the TVA spill site. This alone would have posed an “exceedingly high” risk to workers toiling on the site for long shifts over years, she says.

There are several ways airborne dust can make people sick, Gottlieb says. Fine-ash particles can adhere to the lungs and penetrate deep into the body. Many of these particles contain silica, scourge of the respiratory system, as well as metals such as arsenic, chromium and cadmium, which can cause pulmonary and neurological problems and cancer. The metals mix together in the dust and can attack the same organ at once — the kidneys, for example — amplifying the damage.

Gottlieb’s 2010 report summarizes health hazards posed by nine of the ash’s most common metals and concludes that these “coal ash toxics have the potential to injure all of the major organ systems, damage physical health and development, and even contribute to mortality.”

Physician Michael Harbut says he has seen firsthand the occupational harm caused by coal ash. He has long directed the Center for Occupational and Environmental Medicine at Wayne State University in Michigan. Now semi-retired, he has treated steel-mill employees, construction workers and heavy-equipment operators exposed to the ash. The exposures have left many of his patients suffering from a variety of respiratory and pulmonary illnesses, as well as skin disorders.

Harbut says no one should be surprised that the Kingston cleanup workers have developed conditions such as asthma, bronchitis and emphysema. In 10, 20 or 30 years they could be afflicted with cancers of the “breathing apparatus,” as well as blood cancers. Some already may be developing such diseases.

“I’d expect this to be just the beginning,” Harbut says.

John Cox, a truck driver who worked for four years on the TVA spill site, holds up a page from Jacobs Engineering Group’s site wide safety and health plan, which lists the constituents in the TVA coal ash and their ill health effects.

Kristen Lombardi/Center for Public Integrity

‘I wasn’t there to get sick’

For years, cleanup workers say they suffered in silence as their symptoms progressed — until they could no longer. Some, like Clark, quit working at the TVA spill site in 2013 after chest pains turned into a heart arrhythmia. One day, he collapsed on his bedroom floor. “I decided to pull the plug,” he says. He had passed every union physical except his last in Kingston; every year since, his health has gotten worse. In 2015, he suffered a stroke and was diagnosed with a rare blood disorder. His heart doctor has since attributed his atrial fibrillation in part to the coal ash, records show.

Others turned to supervisors for help. John Cox, a 54-year-old truck driver, says he is a non-smoker who never experienced breathing troubles before his four years cleaning up coal ash. By 2013, he had undergone four antibiotic regimens and was on an inhaler and medication for chronic bronchitis. His doctor wrote a prescription requiring him to wear a respirator on the site. Cox remembers handing it to a Jacobs manager.

“He said, ‘We’re not a drug store. We don’t fill prescriptions,’” says Cox, who paid $21 for a respirator from Lowe’s instead. He began hearing that co-workers were having similar encounters. Kevin Thompson, a 36-year-old truck driver, says he requested a break to administer a doctor-prescribed breathing test after producing multiple prescriptions for a dust mask; he was laid off “due to medical reasons,” records show. Foreman Gibson says he also presented a doctor’s note for a respirator when he made his request for a fitting; he was tested twice and laid off the following year. Brian Thacker, a 46-year-old heavy-equipment operator, says he requested a respirator fitting and a medical screening, only to be jettisoned within weeks.

“I done figured out I didn’t need to be there,” says Cox, who says he opted to quit rather than suffer the same fate.

By then, Cox and other cleanup workers had met Jim Scott, the Knoxville lawyer who has filed lawsuits on their behalf against Jacobs Engineering. In 2014, a federal judge dismissed the workers’ original complaint, ruling that the company had a legal protection of immunity because it was acting under the auspices of TVA — a governmental entity shielded from such claims. Last year, an appellate panel overturned the ruling, and Jacobs appealed to the U.S. Supreme Court. In January, the justices declined to review the case, sending it back to federal court.

In May, Jacobs filed another motion to dismiss the litigation, again arguing it has “qualified immunity . . . as a contractor providing services to the federal government.” As part of its filing, the company submitted affidavits from former TVA safety managers who said that “work site health and safety was something TVA . . . took very seriously,” and that they were unaware of any instance in which “Jacobs inappropriately discouraged or prohibited appropriate use by site workers of equipment,” or “intimidated [workers] from reporting … concerns.”

June 30, 2016

As the case has progressed through the courts — and a total of 51 workers have come forward to file claims to date — Scott has been tracking his clients’ health issues. He remembers cleanup workers arriving in his office in 2011 and 2012, their faces red, their breathing labored. “It was like they had come out of a coal mine,” he says. Today, according to his latest tally, 32 of 43 clients have respiratory and pulmonary problems including sinus infections, chronic bronchitis and lung diseases. He says he was prepared to see these ailments but not the 10 cancers, a number he calls “unusually high.” Some victims, like Mike Shelton, have died. Shelton endured five bouts of pneumonia and a heart attack while working as a truck driver at the TVA spill site from 2009 until last year, when, at age 51, he was diagnosed with lung cancer.

“He believed that place caused his cancer,” his widow, Angela, says. Her husband had quit smoking years ago, she says, and rarely had been sick before his time in Kingston. Shelton died within six weeks of his diagnosis, and after undergoing surgery to remove a lung.

Wilkinson has avoided a cancer diagnosis so far. But he needs a double lung transplant, a $1 million procedure he expects to get by next year. Every day, he uses six liters of oxygen to breathe, twice what he needed two years ago. He has such regular bouts of pneumonia — three or four in May alone — that his doctors write him prescriptions for antibiotics in advance. All attribute his lung disease in part to the coal ash, records show.

Wilkinson remembers his first day on the job at the TVA spill. “I specifically asked about the ash at orientation,” he says, and was told not to worry, it was safe. Looking back, he sees warning signs — the way his bones ached at night, for instance, the way his skin felt “sore sensitive.”

“I was there to do a job and to make a bad situation better,” he says. “I wasn’t there to get sick.”